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Baysal L, Ludolph AC, Wagner J. Clinical and paraclinical features of first unprovoked seizures in the elderly. Epilepsy Behav 2024; 158:109926. [PMID: 38959742 DOI: 10.1016/j.yebeh.2024.109926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE The prevalence of unprovoked seizures and epilepsy rises significantly in later life stages. This study examines various factors in elderly patients (over 65 years) with their first unprovoked seizures, comparing findings with younger patients. METHODS We analyzed electronic medical records of individuals with first unprovoked seizures retrospectively. Diagnosis was based on patient history and witness accounts, and exclusion of other potential causes. Data included demographics, physical examination, seizure characteristics, neuroimaging, EEG findings, laboratory markers, potential causes, prescribed anti-seizure medications (ASMs) at diagnosis and follow-up, seizure-related injuries and hospital stay length. RESULTS We enrolled 391 patients (mean age 73.02 ± 16.5, 219 females). Most had late-onset (≥65 years) seizures (n = 295, 75.5 %). Status epilepticus was diagnosed in 10.2 %, more in the late-onset group. Elderly patients most often had focal seizures with impaired consciousness, while younger patients had focal to bilateral tonic-clonic seizures. (55.9 % vs 36.5 %). Late-onset seizures were linked to cerebrovascular diseases, small vessel disease, and cerebral atrophy, while early-onset cases were associated with brain tumors or unknown causes. Brain imaging revealed potentially epileptogenic abnormalities in 59.1 %. Positive paraneoplastic or autoimmune antibodies were found in 0.8 %. Abnormal EEGs were present in 25.9 %, more in the late-onset group. Most patients were discharged with levetiracetam (LEV) or lamotrigine (LTG) monotherapy. Nine patients with late-onset seizures died during in-hospital follow-up. CONCLUSION Our findings can contribute to the improved identification and characterization of patients with late-onset seizures, facilitating targeted diagnostics and appropriate treatment in this challenging patient population.
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Affiliation(s)
- Leyla Baysal
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, Ulm 89081, Germany.
| | - Albert C Ludolph
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, Ulm 89081, Germany
| | - Jan Wagner
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, Ulm 89081, Germany; Epilepsy Center Ulm, Department of Neurology, University of Ulm, Oberer Eselsberg 45, Ulm 89081, Germany
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2
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Wan X, Zeng Y, Wang J, Tian M, Yin X, Zhang J. Structural and functional abnormalities and cognitive profiles in older adults with early-onset and late-onset focal epilepsy. Cereb Cortex 2024; 34:bhae300. [PMID: 39052362 DOI: 10.1093/cercor/bhae300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 06/26/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
This study aimed to determine the patterns of changes in structure, function, and cognitive ability in early-onset and late-onset older adults with focal epilepsy (OFE). This study first utilized the deformation-based morphometry analysis to identify structural abnormalities, which were used as the seed region to investigate the functional connectivity with the whole brain. Next, a correlation analysis was performed between the altered imaging findings and neuropsychiatry assessments. Finally, the potential role of structural-functional abnormalities in the diagnosis of epilepsy was further explored by using mediation analysis. Compared with healthy controls (n = 28), the area of reduced structural volume was concentrated in the bilateral cerebellum, right thalamus, and right middle cingulate cortex, with frontal, temporal, and occipital lobes also affected in early-onset focal epilepsy (n = 26), while late-onset patients (n = 31) displayed cerebellar, thalamic, and cingulate atrophy. Furthermore, correlation analyses suggest an association between structural abnormalities and cognitive assessments. Dysfunctional connectivity in the cerebellum, cingulate cortex, and frontal gyrus partially mediates the relationship between structural abnormalities and the diagnosis of early-onset focal epilepsy. This study identified structural and functional abnormalities in early-onset and late-onset focal epilepsy and explored characters in cognitive performance. Structural-functional coupling may play a potential role in the diagnosis of epilepsy.
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Affiliation(s)
- Xinyue Wan
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China
- Human Phenome Institute, Fudan University, Shanghai 201203, China
| | - Yanwei Zeng
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China
| | - Jianhong Wang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Mei Tian
- Human Phenome Institute, Fudan University, Shanghai 201203, China
| | - Xuyang Yin
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China
| | - Jun Zhang
- Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, Fudan University, Shanghai 200040, China
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3
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Stefan H, Bösebeck F, Rössler K. Brain tumor-associated epilepsies in adulthood: Current state of diagnostic and individual treatment options. Seizure 2024:S1059-1311(24)00161-4. [PMID: 38910076 DOI: 10.1016/j.seizure.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/14/2024] [Accepted: 06/03/2024] [Indexed: 06/25/2024] Open
Abstract
Brain tumors are one of the most frequent causes of structural epilepsy and set a major burden on treatment costs and the social integrity of patients. Although promising oncological treatment strategies are already available, epileptological treatment is often intractable and requires lifelong epileptological care. Therefore, treatment strategies must be adapted to age-related needs, and specific aspects of late-onset epilepsy (LOE) must be considered. The practical implementation of individual decisions from tumor boards and the current state of the art in scientific knowledge about pathological mechanisms, modern diagnostic procedures and biomarkers, and patient-individualized treatment options into practical epileptological disease management is a prerequisite. This narrative review focuses on the current work progress regarding pathogenesis, diagnosis, and therapy. Exemplarily, interdisciplinary approaches for optimized individualized therapy will be discussed, emphasizing the combination of neurological-epileptological and oncological perspectives.
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Affiliation(s)
- Hermann Stefan
- Department of Neurology, Biomagnetism, University Hospital Erlangen, Germany; Private Practice, 50, Allee am Röthelheimpark, Erlangen, Germany.
| | - Frank Bösebeck
- AGAPLESION Diakonieklinikum Rotenburg, Neurological Clinic - Epilepsy Center, Rotenburg, Germany
| | - Karl Rössler
- Medizinische Universität Wien, Klinik für Neurochirurgie, Wien, Austria
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O'Dwyer R, Foster E, Leppik I, Kwan P. Pharmacological treatment for older adults with epilepsy and comorbid neurodegenerative disorders. Curr Opin Neurol 2023; 36:117-123. [PMID: 36762636 DOI: 10.1097/wco.0000000000001143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
PURPOSE OF REVIEW An increased interest in epilepsy in older adults has emerged as the global population ages. The purpose of this article is to review the literature regarding the pharmacological treatment of epilepsy in older adults, highlighting issues specifically pertinent to those living with comorbid neurodegenerative disorders. RECENT FINDINGS Although new original research remains sparse, in the last 5 years, there has been a growing number of studies addressing the relationship between epilepsy and neurodegenerative disorders. Accurate diagnosis is incredibly challenging with electroencephalogram findings often requiring circumspect interpretation. Older individuals are often excluded from or under-represented in clinical trials, and there are sparse guidelines offered on the management of these patients, with even less available in reference to those with neurodegenerative comorbidities. SUMMARY We propose that seizures occurring earlier in the neurodegenerative process should be treated aggressively, with the goal to inhibit neuro-excitotoxicity and the associated neuronal loss. By strategically choosing newer antiseizure medications with less adverse effects and a holistic approach to treatment, a patient's time living independently can be conserved. In addition, we advocate for original, multinational collaborative research efforts.
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Affiliation(s)
- Rebecca O'Dwyer
- Rush Epilepsy Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Emma Foster
- Central Clinical School, Monash University
- Neurology Department, The Alfred, Melbourne, Victoria, Australia
| | - Ilo Leppik
- MINCEP Epilepsy Care, University of Minnesota, Minneapolis, Minnesota, USA
| | - Patrick Kwan
- Central Clinical School, Monash University
- Neurology Department, The Alfred, Melbourne, Victoria, Australia
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5
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Bank AM, Kuzniecky R, Knowlton RC, Cascino GD, Jackson G, Pardoe HR. Structural Neuroimaging in Adults and Adolescents With Newly Diagnosed Focal Epilepsy: The Human Epilepsy Project. Neurology 2022; 99:e2181-e2187. [PMID: 35985821 PMCID: PMC9651452 DOI: 10.1212/wnl.0000000000201125] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Identification of an epileptogenic lesion on structural neuroimaging in individuals with focal epilepsy is important for management and treatment planning. The objective of this study was to determine the frequency of MRI-identified potentially epileptogenic structural abnormalities in a large multicenter study of adolescent and adult patients with newly diagnosed focal epilepsy. METHODS Patients with a new diagnosis of focal epilepsy enrolled in the Human Epilepsy Project observational cohort study underwent 3 T brain MRI using a standardized protocol. Imaging findings were classified as normal, abnormal, or incidental. Abnormal findings were classified as focal or diffuse and as likely epilepsy-related or of unknown relationship to epilepsy. Fisher exact tests were performed to determine whether abnormal imaging or abnormality type was associated with clinical characteristics. RESULTS A total of 418 participants were enrolled. Two hundred eighteen participants (59.3%) had no abnormalities detected, 149 (35.6%) had abnormal imaging, and 21 (5.0%) had incidental findings. Seventy-eight participants (18.7%) had abnormalities that were considered epilepsy-related, and 71 (17.0%) had abnormalities of unknown relationship to epilepsy. Older participants were more likely to have imaging abnormalities, while participants with focal and epilepsy-related imaging abnormalities were younger than those without these abnormalities. One hundred thirty-one participants (31.3%) had a family history of epilepsy. Epilepsy-related abnormalities were not associated with participant sex, family history of epilepsy, or seizure type. DISCUSSION We found that 1 in 5 patients with newly diagnosed focal epilepsy has an MRI finding that is likely causative and may alter treatment options. An additional 1 in 5 patients has abnormalities of unknown significance. This information is important for patient counseling, prognostication, and management.
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Affiliation(s)
- Anna M Bank
- From the Department of Neurology (A.M.B., R.K.), Lenox Hill Hospital/Northwell Health, New York City; Department of Neurology (A.M.B., R.K.), Zucker School of Medicine at Hofstra University, Hempstead, NY; Department of Neurology (R.C.K.), University of California, San Francisco; Department of Neurology (G.D.C.), Mayo Clinic, Rochester, MN; Florey Institute for Neuroscience and Mental Health (G.J.), Parkville, Australia; and Department of Neurology (H.R.P.), New York University School of Medicine
| | - Ruben Kuzniecky
- From the Department of Neurology (A.M.B., R.K.), Lenox Hill Hospital/Northwell Health, New York City; Department of Neurology (A.M.B., R.K.), Zucker School of Medicine at Hofstra University, Hempstead, NY; Department of Neurology (R.C.K.), University of California, San Francisco; Department of Neurology (G.D.C.), Mayo Clinic, Rochester, MN; Florey Institute for Neuroscience and Mental Health (G.J.), Parkville, Australia; and Department of Neurology (H.R.P.), New York University School of Medicine
| | - Robert C Knowlton
- From the Department of Neurology (A.M.B., R.K.), Lenox Hill Hospital/Northwell Health, New York City; Department of Neurology (A.M.B., R.K.), Zucker School of Medicine at Hofstra University, Hempstead, NY; Department of Neurology (R.C.K.), University of California, San Francisco; Department of Neurology (G.D.C.), Mayo Clinic, Rochester, MN; Florey Institute for Neuroscience and Mental Health (G.J.), Parkville, Australia; and Department of Neurology (H.R.P.), New York University School of Medicine
| | - Gregory D Cascino
- From the Department of Neurology (A.M.B., R.K.), Lenox Hill Hospital/Northwell Health, New York City; Department of Neurology (A.M.B., R.K.), Zucker School of Medicine at Hofstra University, Hempstead, NY; Department of Neurology (R.C.K.), University of California, San Francisco; Department of Neurology (G.D.C.), Mayo Clinic, Rochester, MN; Florey Institute for Neuroscience and Mental Health (G.J.), Parkville, Australia; and Department of Neurology (H.R.P.), New York University School of Medicine
| | - Graeme Jackson
- From the Department of Neurology (A.M.B., R.K.), Lenox Hill Hospital/Northwell Health, New York City; Department of Neurology (A.M.B., R.K.), Zucker School of Medicine at Hofstra University, Hempstead, NY; Department of Neurology (R.C.K.), University of California, San Francisco; Department of Neurology (G.D.C.), Mayo Clinic, Rochester, MN; Florey Institute for Neuroscience and Mental Health (G.J.), Parkville, Australia; and Department of Neurology (H.R.P.), New York University School of Medicine
| | - Heath R Pardoe
- From the Department of Neurology (A.M.B., R.K.), Lenox Hill Hospital/Northwell Health, New York City; Department of Neurology (A.M.B., R.K.), Zucker School of Medicine at Hofstra University, Hempstead, NY; Department of Neurology (R.C.K.), University of California, San Francisco; Department of Neurology (G.D.C.), Mayo Clinic, Rochester, MN; Florey Institute for Neuroscience and Mental Health (G.J.), Parkville, Australia; and Department of Neurology (H.R.P.), New York University School of Medicine
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Bartolini E, Ferrari AR, Lattanzi S, Pradella S, Zaccara G. Drug-resistant epilepsy at the age extremes: Disentangling the underlying etiology. Epilepsy Behav 2022; 132:108739. [PMID: 35636351 DOI: 10.1016/j.yebeh.2022.108739] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/02/2022] [Accepted: 05/11/2022] [Indexed: 11/03/2022]
Abstract
The incidence of epilepsy is highest at the extreme age ranges: childhood and elderly age. The most common syndromes in these demographics - self-limited epilepsies of childhood and idiopathic generalized epilepsies in pediatric age, focal epilepsy with structural etiology in older people - are expected to be drug responsive. In this work, we focus on such epilepsy types, overviewing the complex clinical background of unexpected drug-resistance. For self-limited epilepsies of childhood and idiopathic generalized epilepsies, we illustrate drug-resistance resulting from syndrome misinterpretation, reason on possible unexpected courses of epilepsy, and explicate the influence of inappropriate treatments. For elderly-onset epilepsy, we show the challenges in differential diagnosis possibly leading to pseudoresistance and analyze how drug-resistant epilepsy can arise in stroke, neurocognitive disorders, brain tumors, and autoimmune encephalitis. In children and senior people, drug-resistance can be regarded as a hint to review the diagnosis or explore alternative therapeutic strategies. Refractory seizures are not only a therapeutic challenge, but also a cardinal sign not to be overlooked in syndromes commonly deemed to be drug-responsive.
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Affiliation(s)
- Emanuele Bartolini
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy.
| | - Anna Rita Ferrari
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy.
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Silvia Pradella
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, Prato, Italy.
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Hourani R, Nasreddine W, Dirani M, Hmaimess G, Sabbagh S, El Tourjuman O, Wazne J, Toufaili H, AlArab N, El Dassouki M, Beydoun A. When Should a Brain MRI Be Performed in Children with New-Onset Seizures? Results of a Large Prospective Trial. AJNR Am J Neuroradiol 2021; 42:1695-1701. [PMID: 34244128 DOI: 10.3174/ajnr.a7193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/05/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There is a paucity of data regarding the incidence of structural brain lesions in children with new-onset unprovoked seizures. Our aim was to determine the frequencies and types of epileptogenic lesions detected on a dedicated epilepsy protocol MR imaging according to age group, the presence of developmental delay, and the number and types of seizures. MATERIALS AND METHODS Consecutive children between 6 months and 18 years of age with new-onset unprovoked seizures were included. The frequencies and types of epileptogenic lesions were determined and then stratified according to sex, age groups, the presence of developmental delay, and the number and types of seizures at presentation. Multivariate analysis was used to identify variables significantly associated with the presence of epileptogenic lesions. RESULTS One thousand children were included. An epileptogenic lesion was identified in 26%, with malformations of cortical development being the most common lesion (32%), followed by hypoxic-ischemic injury (20%) and vascular etiologies (16%). Univariate analysis showed a significant increase in the frequency of epileptogenic lesions with decreasing age, the presence of developmental delay, and the number and types of seizures at presentation. The presence of developmental delay and seizure type at presentation remained significant in a multivariate analysis. CONCLUSIONS We documented a relatively high rate of epileptogenic lesions in children with new-onset seizures, with the presence of developmental delay and specific seizure types being associated with a higher likelihood of detecting an epileptogenic lesion on neuroimaging. This study fulfills the requirements of the study design recommended by the Practice Committee of the American Academy of Neurology, and we hope that our results will assist the relevant societies and committees in formulating neuroimaging guidelines for children with new-onset seizures.
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Affiliation(s)
- R Hourani
- Department of Radiology (R.H., N.A.), American University of Beirut Medical Center, Beirut, Lebanon
| | - W Nasreddine
- Department of Neurology (W.N., M.D., A.B.), American University of Beirut Medical Center, Beirut, Lebanon
| | - M Dirani
- Department of Neurology (W.N., M.D., A.B.), American University of Beirut Medical Center, Beirut, Lebanon
| | - G Hmaimess
- Department of Pediatrics (G.H.), St George Hospital Medical University Center, University of Balamand, Beirut, Lebanon
| | - S Sabbagh
- Department of Pediatrics (S.S.), Hotel Dieu de France Hospital, Beirut, Lebanon
| | - O El Tourjuman
- Department of Neurology (O.E.T., J.W., M.E.D.), Rafic Hariri University Hospital, Beirut, Lebanon
| | - J Wazne
- Department of Neurology (O.E.T., J.W., M.E.D.), Rafic Hariri University Hospital, Beirut, Lebanon
| | - H Toufaili
- Labib Medical Center (H.T.), Beirut, Lebanon
| | - N AlArab
- Department of Radiology (R.H., N.A.), American University of Beirut Medical Center, Beirut, Lebanon
| | - M El Dassouki
- Department of Neurology (O.E.T., J.W., M.E.D.), Rafic Hariri University Hospital, Beirut, Lebanon
| | - A Beydoun
- Department of Neurology (W.N., M.D., A.B.), American University of Beirut Medical Center, Beirut, Lebanon
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Alsfouk BAA, Hakeem H, Chen Z, Walters M, Brodie MJ, Kwan P. Characteristics and treatment outcomes of newly diagnosed epilepsy in older people: A 30‐year longitudinal cohort study. Epilepsia 2020; 61:2720-2728. [DOI: 10.1111/epi.16721] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Bshra Ali A. Alsfouk
- Department of Pharmaceutical Sciences College of Pharmacy Princess Nourah Bint Abdulrahman University Riyadh Saudi Arabia
- University of Glasgow Glasgow UK
| | - Haris Hakeem
- Department of Neuroscience Central Clinical School Monash University Alfred Hospital Melbourne Vic. Australia
| | - Zhibin Chen
- Department of Neuroscience Central Clinical School Monash University Alfred Hospital Melbourne Vic. Australia
- Department of Medicine – Royal Melbourne Hospital The University of Melbourne Melbourne Vic. Australia
- Clinical Epidemiology School of Public Health and Preventive Medicine Monash University Melbourne Vic. Australia
| | | | | | - Patrick Kwan
- Department of Neuroscience Central Clinical School Monash University Alfred Hospital Melbourne Vic. Australia
- Department of Medicine – Royal Melbourne Hospital The University of Melbourne Melbourne Vic. Australia
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Mutoh T, Eguchi K, Yamamoto S, Yasui N, Taki Y. Arterial Spin Labeling Magnetic Resonance Imaging in the Assessment of Non-Convulsive Status Epilepticus in Alzheimer's Disease: A Report of Two Cases. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1883-1887. [PMID: 31841453 PMCID: PMC6930695 DOI: 10.12659/ajcr.919938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Case series Patients: Female, 69-year-old • Male, 70-year-old Final Diagnosis: Nonconvulsive status epilepticus Symptoms: Altered mental status • cognitive impairment Medication: — Clinical Procedure: ASL perfusion MRI Specialty: Neurology
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Affiliation(s)
- Tatsushi Mutoh
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging, and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Kaoru Eguchi
- Sendai East Neurosurgical Hospital, Sendai, Miyagi, Japan
| | - Shuzo Yamamoto
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging, and Cancer, Tohoku University, Sendai, Miyagi, Japan.,Sendai East Neurosurgical Hospital, Sendai, Miyagi, Japan
| | - Nobuyuki Yasui
- Sendai East Neurosurgical Hospital, Sendai, Miyagi, Japan
| | - Yasuyuki Taki
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging, and Cancer, Tohoku University, Sendai, Miyagi, Japan
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Watkins L, O'Dwyer M, Shankar R. New anti-seizure medication for elderly epileptic patients. Expert Opin Pharmacother 2019; 20:1601-1608. [PMID: 31112437 DOI: 10.1080/14656566.2019.1618272] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Epilepsy treatment in older people requires specific consideration owing to more physical co-morbidities, the risk of drug-to-drug interactions through polypharmacy, and differences in pharmacodynamics and pharmacokinetics. There are many 'newer' antiepileptic drugs (AEDs) widely used for various seizure types and seizure disorders. However, there is limited specific evidence for the efficacy, safety, and tolerability of these treatments in the elderly population. Areas covered: This review summarises the current most robust evidence available for the use of the newer AEDs belonging to generation two and three in elderly people with epilepsy. The article provides practical evidenced based clinical information to help prescribers choose the most appropriate AED from the drugs discussed. Expert opinion: Diagnosing new onset epilepsy in the elderly population requires specialist assessment. Treatment plans need to be tailored to accommodate an individual's co-morbidities, concurrent medications, and general health status. To date, few clinical investigations consider the elderly population specifically despite the increased risk factors. There is a need for large quality trial data to assess the impact of the newest AEDs on seizure control and quality of life in this population with complex needs.
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Affiliation(s)
- Lance Watkins
- Neath Port Talbot CLDT, Mental Health & Learning Disability Delivery Unit, Abertawe Bro Morgannwg University Health Board, LLwyneryr Unit , Morriston , UK
| | - Máire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin , Dublin , Ireland
| | - Rohit Shankar
- Developmental Neuropsychiatry Department, Cornwall Partnership NHS Foundation Trust , Truro , UK.,Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital , Truro , UK
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